Suggested Updates in Vascular Surgery Training in Pakistan

By Zia Ur Rehman

Affiliations

1. Department of Surgery, Aga Khan University and Hospital, Karachi, Pakistan

doi: 10.29271/jcpsp.2026.07.965

Sir,

Vascular surgery as a speciality in Pakistan has undergone a visible transformation over the last two decades. What was once the province of a handful of general, cardiac, or trauma surgeons with an interest in the field has progressively evolved into a distinct speciality with dedicated training pathways and academic activity.¹ Aga Khan University Hospital implemented a dedicated two-year vascular fellowship program in 2003, and over time, this programme became a model for structured vascular training in the country. The speciality was recognised by the College of Physicians and Surgeons of Pakistan (CPSP) in 2015. Since then, speciality has rapidly progressed with 10 recognised training centres in Pakistan, and the number of hospitals offering vascular surgery services has also increased. Awareness of vascular diseases has also increased among both the public and physicians, and this is directly related to the increasing number of training centres within the country. Despite progress, the absolute number of recognised training centres and supervisors remains modest compared with national need.² Vascular surgery is a second fellowship after general surgery. It takes 7 years for a physician to become a vascular surgeon after completion of his/her graduation and internship. Four years of general surgery, one gap year, and 2 years  of  dedicated  vascular  surgery  training.

During an interaction with trainees and supervisors at the Annual conference of the Society of Vascular Surgery in Karachi, most trainees and supervisors were found to be satisfied with the case volume for open surgical procedures; however, they felt that opportunities and training for endovascular skills could be improved. There are a few barriers to achieving optimal training in vascular surgery. This includes the availability of a radiology suite, facilities for using a C-arm, and adequate inventory. There is also an inconsistency of case volume in different centres. Trainees have varying exposure to aortic procedures, peripheral bypass procedures, and carotid endarterectomy across different centres. There is also a strong opinion that the duration of training should be increased and that there should be more opportunities for training in endovascular skills. The current training needs to be expanded to at least three years of core vascular surgery training to provide a better case mix, higher volume, and greater exposure to endovascular procedures  for  trainees.

COMPETING  INTEREST:
The  author  declared  no  conflict  of  interest.

AUTHOR’S  CONTRIBUTIONS:
ZUR: Concept, data collection, manuscript writing, critical review, and approval of the final version of the manuscript to be published.

REFERENCES

1. Rehman ZU, Sophie Z. Vascular surgery in Pakistan: Critical issues. J Coll Physicians Surg Pak 2014; 24(6):381-2.
2. Ehsan O. Present state of vascular surgery in Pakistan. Pak J Med Health Sci 2024; 18(5):1. doi: 10.53350/pjmhs0202 4185.ed1.